title: Yeasts isolated from nosocomial urinary infections: antifungal susceptibility and biofilm production.
abstract: BACKGROUND
  Urinary Candida infections in the hospital environment are frequent and need to be better understood.
  
  
  OBJECTIVE
  To compare the results of antifungal susceptibility profiles of yeasts isolated from patients with urinary infections obtained by broth microdilution method (BM) and by disk diffusion (DD), and also evaluate the capacity of these yeasts to form biofilms.
  
  
  METHODS
  Only yeasts obtained from pure urine cultures with counts higher than 10(5) colony-forming units per milliliter, without bacteria development, of symptomatic patients were included. The isolates were identified by classical methods and the antifungal susceptibility tests were performed with the following drugs: amphotericin B, ketoconazole, fluconazole, itraconazole, voriconazole and caspofungin. The biofilm studies were carried out in polystyrene microtitration plates.
  
  
  RESULTS
  Ninety-five yeasts isolates were analyzed, including 40 Candida albicans, 31 Candida glabrata, 24 Candida tropicalis. In general, the majority of the isolates were susceptible to the tested drugs but some resistance was observed, especially against fluconazole. Great variability in the antifungal susceptibility results was observed with the different tested drugs and a few discrepancies were observed between both methods. We suggest that in case of DD resistance this result should be confirmed by BM, the standard method. C. tropicalis isolates showed high biofilm production (91.7%) compared to C. albicans (82.5%) and C. glabrata (61.3%), with statistical significance (p=0.0129).
  
  
  CONCLUSIONS
  Candiduria in critical patients requires major attention and a better control. The different susceptibility results obtained in this study showed the need to identify yeasts up to the species level, especially in patients with urinary tract infection. The development of techniques of antifungal susceptibility tests can help the clinicians in the empiric treatment of candiduria.
authors.affiliation: Teaching and Research in Clinical Analysis Laboratory, Division of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil.
authors.forename: Alessandra Ribeiro
authors.initials: AR
authors.lastname: de Freitas
authors.affiliation: Teaching and Research in Clinical Analysis Laboratory, Division of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil.
authors.forename: Lilian Cristiane
authors.initials: LC
authors.lastname: Baeza
authors.affiliation: Teaching and Research in Clinical Analysis Laboratory, Division of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil.
authors.forename: Maria Graciela Iecher
authors.initials: MG
authors.lastname: Faria
authors.affiliation: Teaching and Research in Clinical Analysis Laboratory, Division of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil.
authors.forename: Kelen Fátima Dalben
authors.initials: KF
authors.lastname: Dota
authors.affiliation: Instituto de Microbiología Clínica, Facultad de Medicina, Universidad Austral de Chile, Valdivia, XIV Región, Chile.
authors.forename: Patrício
authors.initials: P
authors.lastname: Godoy Martínez
authors.affiliation: Teaching and Research in Clinical Analysis Laboratory, Division of Medical Mycology, State University of Maringá, Maringá, Paraná, Brazil. Electronic address: terezinha.svidzinski@gmail.com.
authors.forename: Terezinha Inez Estivalet
authors.initials: TI
authors.lastname: Svidzinski
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D018441:Biofilms; D001938:Brazil; D002176:Candida albicans / Q000187:drug effects / Q000302:isolation & purification* / Q000502:physiology; D041221:Candida glabrata / Q000187:drug effects / Q000302:isolation & purification* / Q000502:physiology; D041022:Candida tropicalis / Q000187:drug effects / Q000302:isolation & purification* / Q000502:physiology; D002177:Candidiasis / Q000188:drug therapy / Q000382:microbiology*; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology*; D025141:Drug Resistance, Fungal; D026141:Drug Resistance, Multiple, Fungal; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D013045:Species Specificity; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D000935:Antifungal Agents
keywords: Biofilm; Broth microdilution; Candiduria; Difusión con disco; Disk diffusion; Infección urinaria; Microdilución en caldo; Urinary infection